Importance of mixture of minor determinants and benzylpenicilloyl poly-l-lysine skin testing in the diagnosis of β-lactam allergy

Bousquet, Philippe‐Jean; Co-Minh, H.-B.; Arnoux, B.; Jp, Daurès; Demoly, Pascal

doi:10.1016/j.jaci.2005.02.026

Cited by 79 publications

(56 citation statements)

References 9 publications

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“…Furthermore, an early study by Macy and colleagues [80] found that up to 20% of patients were only positive to minor determinants (penilloate and penicilloate). The importance of including both PPL and MDM determinants has been confirmed in two series of patients with hypersensitivity reactions to beta-lactams [81,123]. In this retrospective series which included reactions to aminopenicillins, penicillin V, cephalosporins, etc., if PPL or MDM had been omitted from testing, 14.7% and 47%, respectively, of beta-lactam allergic patients would have been missed.…”

Section: Skin Test Reagentsmentioning

confidence: 84%

“…Once administered, penicillin undergoes spontaneous degradation because of a chemically unstable b-lactam ring, forming reactive intermediate products which can bind to lysine residue aminogroups on soluble or cell-bound proteins [13,78,79]. This results in the formation of benzyl penicilloyl, the major antigenic determinant of penicillin against which the majority of allergic patients react [80,81].…”

Section: Molecular Structurementioning

confidence: 99%

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Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

217

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Skin Test Reagentsmentioning

confidence: 84%

Section: Molecular Structurementioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

217

229

View full text Add to dashboard Cite

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“…In this context, and after reviewing studies [19][20][21] and guidelines from Europe [19], little long-term thinking seems to have occurred and little effort made to begin developing and standardizing a wider range of improved -lactam test agents.…”

Section: Test Materials For In Vivo and In Vitro Usementioning

confidence: 99%

Antibiotic allergy: Immunochemical and clinical considerations

Baldo¹,

Zhao²,

Pham³

2008

Curr Allergy Asthma Rep

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Antibiotics are among the most widely and heavily prescribed drugs, but despite this, allergic reactions to most groups of antibiotics are relatively uncommon-especially when compared with the number and frequency of type 1 hypersensitivity responses to the beta-lactams (ie, penicillins, cephalosporins, and, to a lesser extent, carbopenems). Still, there remains a steady flow of reports of allergic reactions to some topically used antibiotics (eg, rifamycin SV and bacitracin). Moreover, aminoglycosides (eg, neomycin and gramicidin) may be implicated more often than previously suspected. Despite advances in our understanding of the structural basis of the allergenicity of beta-lactam antibiotics, the insights have not readily transferred into routine use to improve diagnoses of reactions to individual penicillins and cephalosporins. This remains a challenge in drug allergy, as does the need for further chemical, immunologic, and clinical research on cephalosporin breakdown products and the so-called multiple antibiotic allergy syndrome.

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“…Entretanto, todos os esquemas são definidos com base no aumento progressivo das concentrações do medicamento a ser administrado, iniciandose por amostras muito diluídas e concluindo-se o processo com preparados em diluições similares às que serão utilizadas (Tabela 4). No caso da penicilina, a dessensibilização é indicada quando não houver possibilidade de substituição do medicamento 20,21,31 .…”

Section: O Diagnóstico De Alergia Foi Confirmado E a Dessensibilização?unclassified

Allergy to beta-lactams in pediatrics: a practical approach

Grumach

2006

J Pediatr (Rio J)

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Objective: To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics.Sources: Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts.Summary of the findings: Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10% of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95%) and minor determinants (5%). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95% of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. Conclusions:The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.J Pediatr (Rio J). 2006;82(5 Suppl):S181-8: Beta-lactam, penicillin, cephalosporin, allergy, hypersensitivity reaction. ResumoObjetivo: Apresentar uma abordagem prática ao diagnóstico e conduta na alergia a antibióticos beta-lactâmicos.Fontes dos dados: Periódicos da área de alergia indexados nas bases MEDLINE e LILACS, além de estudos e textos clássicos que tratam do tema. Síntese dos dados:A alergia à penicilina é relatada com freqüên-cia, em muitos casos resultando na exclusão desse medicamento do arsenal terapêutico. Cerca de 10% dos relatos de alergia a drogas são confirmados. As manifestações clínicas decorrentes da reação alérgica à penicilina são bastante amplas, destacando-se os quadros cutâneos. Os quatro mecanismos de hipersensibilidade de Gell & Coombs estão envolvidos nas reações alérgicas. A penicilina é degradada em determinante maior (95% dos produtos) e em determinantes menores (5% dos produtos). As reações imediatas, mediadas por IgE, e que determinam quadros de anafilaxia, estão relacionadas aos determinantes menores em 95% dos casos. A hipersensibilidade a esses produtos pode ser avaliada através de testes cutâneos realizados com os determinantes maior e menores, permitindo, assim, evitar o choque anafilático em indivíduos alérgicos. O texto ressalta conhecimentos básicos sobre a alergia à penicilina, propiciando um diagnóstico mais adequado desse evento e a conduta em casos de suspeita de alergia a beta-lactâmicos.Conclusões: O diagnóstico de alergia à penicilina tem sido feito de forma inadequada, resultando em sua exclusão do arsenal terapêutico. O melhor reconhecimento dessas cond...

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Importance of mixture of minor determinants and benzylpenicilloyl poly-l-lysine skin testing in the diagnosis of β-lactam allergy

Cited by 79 publications

References 9 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Antibiotic allergy: Immunochemical and clinical considerations

Allergy to beta-lactams in pediatrics: a practical approach

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